The Dextromethorphan FAQ
Answers to Frequently Asked Questions about DXM
v 4.02 - Copyright © 1997,2001 All Rights Reserved
Used at Erowid with the permission of the author
Erowid Note: This FAQ was not authored by Erowid. It may include out-of-date and/or incorrect information. Please check the version date to see when it was most recently revised. It appears on Erowid as part of our historical archives. For current information, see Erowid's summary pages in the substance's main vault.
- 4.04: May 20, 2003: erowid correction added to 11.6.1
- 4.03: Sep 22, 2001: erowid change to 18.104.22.168 (again)
- 4.02: July 17, 2001: erowid change to 22.214.171.124
- 4.01: June 7, 2001: erowid minor addition to 5.3.4
New Section: Moron of the Moment
New Section on Quitting DXM
Introduction to the FAQ v4.0
A lot has happened since I published Version 3 of the DXM FAQ; some of it has been good, some not so good. I'd like to take a moment to address some of these changes and some of my concerns. I still do not regret having published the FAQ, and out of all the feedback I have received (including letters from physicians, scientists, parents, and just plain druggies), less than one percent has been negative. The reasons I gave for its publication still apply, but those of you familiar with v3.0 will notice that this version shows considerably less praise for DXM.
When I published the FAQ on Usenet (and then the World Wide Web), it was my expectation that it would be of interest primarily to psychonauts, experienced psychedelic users, and others who use drugs for self-exploration and spiritual purposes. I knew, of course, that not everyone who did DXM would use it with the intention of expanding the mind, but I reasoned that, given the relative unpleasantness of consuming cough syrup, and the "heaviness" of the DXM experience, most people would find casual, recreational use of DXM unlikely. Things didn't quite turn out how I expected.
Also at that time there was a severe shortage of information from former DXM users about adverse effects of long-term use. I had reasoned that long-term use was probably not a good idea, but probably not terribly dangerous. Of the people I had interviewed who had used DXM regularly, very few had any problem with it, and those who did recovered when they stopped using it.
Since then there has been a great increase in DXM use (or at least more people are talking about it). My concern that the FAQ had started a "DXM epidemic" turned out to be mostly baseless; the majority of new DXM users seem to hear about it the same way that DXM users have always learned about it: from their friends. Some do learn about it from the FAQ, but for the most part you have to know about DXM in the first place before finding or understanding the FAQ.
As I have spoken to more and more users of DXM, I have learned that more people have negative experiences with the drug than I had expected. Most of these are simply people who try it once, decide they don't like it, and never try it again. A few people, on the other hand, seem to be greatly susceptible to DXM addiction and some of these have suffered long-term health consequences. A very few may have suffered permanent brain damage from extremely heavy use of DXM (e.g., an 8oz bottle of Maximum Strength syrup every day). On the other hand, some people consume the same amount for years seemingly without consequence. And while some people can consume DXM regularly without psychological consequences, others suffer from severe depression and psychotic breaks, even leading to a few cases of suicide attempts.
This brings me to the most relevant new information about DXM: Olney's findings of NMDA Antagonist Neurotoxicity (NAN). There is great debate right now whether NAN is relevant at recreational doses or not. In animals, the dosage required to induce NAN is far in excess of the anaesthetic dose, and humans typically take sub-anaesthetic doses of dissociatives. On the other hand, there may be danger with long-term use at considerably lower dosages that the animal models do not show.
The data from human experiences are hard to interpret. Many heavy PCP users suffer obvious cognitive and motor impairment; however, PCP has neurotoxic effects (in particular in the cerebellum) not shared by other dissociatives including DXM or ketamine. Ketamine is probably a better approximation of DXM, but very few people have done large amounts of ketamine for long periods of time. A notable exception is John Lilly, who is a bit of a nut, but was probably a bit of a nut before doing ketamine, and (at least the last time I checked) he doesn't seem to suffer from cognitive impairment.
There are a few DXM users who have suffered long-term consequences. Out of approximately five hundred current and former DXM users I have heard from, three have suffered lasting cognitive impairment. Additionally, there is one published paper on cognitive impairment from chronic DXM use, although the author suggests an underlying temporal lobe seizure disorder. DXM has been shown to increase the frequency of complex partial seizures, and it's possible that it is the seizures, and not the DXM itself, which is causing problems. Unfortunately, it has also been suggested temporal lobe epileptics may also be more susceptible to dissociative addiction. Hopefully much of this will be resolved in the next few years.
Until then, my official recommendation is not to use DXM at all. Since I know this isn't likely to happen, my own personal belief is that DXM is probably pretty safe when used occasionally (e.g., once or twice a month) at the lower plateaus, and rarely (e.g., once or twice a year) at the higher plateaus. I have yet to hear from anyone who used DXM with this or less frequency who has suffered any impairment, temporary or permanent. Actually, to be technically correct, nobody using it once a week for less than six months has ever seemed to have problems, but it's always best to keep a wide safety margin.
Another thing to keep in mind is that DXM in the upper plateaus is a considerably different experience than the lower plateaus, and may be better suited to spiritual or ritual use. Even at the lower plateaus, DXM is not really well suited as a frequent recreational drug.
So what do you do then if you find yourself in that particularly human condition of ennui (for which psychedelics are a most effective medicine)? Well, ideally I'd suggest you hop on a plane to Amsterdam (or somewhere else where 2CB and marijuana are legal). Unfortunately this isn't an ideal world, and flying across the Atlantic is outside the means of most of us (including me). A more reasonable suggestion would be to do your part to change the laws in this country so that psychedelics can regain their rightful place as tools for mental, emotional, and spiritual exploration and growth. Remember, the laws aren't going to change unless we work to change them.
In summary, I'm not nearly as convinced that DXM is a benevolent psychedelic as I used to be. It is in many ways considerably more powerful (and certainly more dangerous) than LSD or mushrooms. Like all psychedelics it can profoundly change you; unlike others, these changes are not necessarily under your control, especially if you are not very familiar with yourself. DXM can be a great tool for spiritual rebirth, but it can also turn you into a paranoid, antisocial asshole. I still believe that DXM has a place among psychedelics, but do understand that it is not a replacement for LSD, mushrooms, 2CB, or even ketamine. It is a unique and uniquely powerful mind-altering drug, and one which I think most people would do best to avoid.
March 15, 1997
Introduction to the FAQ v3.0
This document is a FAQ ("fack"), i.e., a series of questions and answers. The term comes from Usenet, and stands for Frequently Asked Questions. These are the sorts of questions that people new to Usenet tend to ask frequently. When these questions become frequent enough, the question and its answer may be placed into the FAQ for the newsgroup (or for a topic within the newsgroup). A few people use the term AFAQ (Answers to Frequently Asked Questions), but most use FAQ to refer both to a frequent question and to the document
This FAQ covers dextromethorphan (decks-tro-meth-OR-fan), the cough suppressant commonly found in cough medicines available over-the-counter in the USA and other parts of the world. Of course, dextromethorphan (DXM) does more than suppress coughs; otherwise, there wouldn't be so much discussion about it on Usenet. The bizarre truth about DXM is that it is a very potent psychoactive drug when taken in sufficient quantities. So if you've ever heard about people drinking cough syrup for fun, well, now you know why.
The trouble, however, is that most cough medicines have other ingredients which can make you uncomfortable, sick, or dead, depending on the ingredient and how much you take. Furthermore, even when pure, chronic or heavy use of DXM may cause health problems. This document is intended to combat potentially dangerous misinformation about the recreational use of DXM, and to allow you to make an intelligent and informed decision about DXM.
My own interest in DXM came quite by accident; once, while sick with the flu, I misread the instructions on a bottle of cough syrup and drank two shots from the included shotglass instead of two teaspoons. Soon after I noticed that music and motion had become very satisfying experiences. This left me puzzled, and my reaction was to go to the library and research DXM through Medline, medical journals, and books.
Of course at that point I was hooked - not on DXM, but on neuropharmacology. I decided to learn as much as I could about DXM, and found it to be one of the most unique and interesting of all recreational drugs in terms of how it works on the brain.
About this time I noticed a number of incorrect and potentially dangerous posts (articles) about DXM appearing on alt.drugs. So, I decided to gather the information I had and write a FAQ. It eventually became much more than a FAQ, giving explanations and information in addition to answers, but by then the name had stuck. The FAQ took me over 150 hours to complete - I figured if I'm going to do it, I'd better do it right.
After publishing the DXM FAQ, the reports of DXM use started coming in. People who had been using DXM but were uncomfortable talking about "getting high off cough syrup" shared their stories with me. Some were good, some were bad, some indifferent. I've been trying my best to get all of these personal reports together into a coherent whole, but this FAQ is written in my free time and I don't get paid for it (although donations are acceptable :^).
Please note that it is not my intention to get a bunch of people hooked on cough syrup (actually addiction is very rare, but you get my point). It is my intention for people to know the truth so they don't make bad decisions for lack of knowledge. DXM is not safe and harmless; nothing is. Nor is it universally enjoyable; in fact, some find high-dose DXM experiences terrifying. But I believe that people can only make good decisions, or learn from bad decisions, if information is available. So please, use your head!